The prevalence of risk factors and pattern of obstructive coronary artery disease in young indians (< 45 years) undergoing percutaneous coronary intervention: a gender-based multi-center study

Funding Acknowledgements

Type of funding sources: None.

Background

In a retrospective study, we aimed to explore the prevalence of risk factors and trends of obstructive coronary artery disease (CAD) in Indian females under 45 years old compared to males of the same age group who underwent percutaneous coronary intervention (PCI).

Purpose

With changing lifestyles, the onset of traditional risk factors at the early stages of life is the major culprit for developing CAD at an early age. For several years, the significance of CAD in young women was underestimated. There are some sex-related variations in CAD, and symptoms of CAD in women, regardless of age, have low specificity even in the absence of risk factors.

Materials and Methods

This was a retrospective, observational, multi-centre study of young Indian females and males (< 45 years) who underwent PCI as per the guidelines at three high-volume centres of India. The study evaluated the prevalence of risk factors, clinical and angiographic patterns of obstructive CAD in young Indian women compared to men.

Results

In a cohort of 3656 patients who underwent PCIs, 113 young females comprised 3.1% of those with obstructive CAD, while 254 young males constituted 6.9%. Traditional risk factors such as hypertension, diabetes, and family history of premature CAD were the most common in both genders, whereas dyslipidaemia, obesity, smoking, and alcoholism were more common in young males. The acute coronary syndrome was the most common clinical presentation. The single-vessel disease was common with the involvement of the left anterior descending artery as a most common angiographic feature. The prevalence of cardiogenic shock was 4.4% in females and 4.1% in males while the in-hospital mortality rate was 1.77% in young females and 2% in young males.

Conclusion

CAD in young Indians is on the rise, and frequent screening for obstructive CAD should be done, especially in those with symptoms and risk factors.

Changing pattern of admissions for acute myocardial infarction in India during the COVID-19 pandemic

AIM

Studies on the changes in the presentation and management of acute myocardial infarction (AMI) during the COVID-19 pandemic from low- and middle-income countries are limited. We sought to determine the changes in the number of admissions, management practices, and outcomes of AMI during the pandemic period in India.

METHODS & RESULTS

In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with AMI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We included 41,832 consecutive adults with AMI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India. The weekly average decrease in AMI admissions in 2020 correlated negatively with the number of COVID cases (r = -0·48; r2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively.

CONCLUSIONS

The magnitude of reduction in AMI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing AMI during the pandemic.

DEVELOPMENT OF NACL-BASED OPTICALLY STIMULATED LUMINESCENT PHOSPHORS FOR THE POSSIBLE APPLICATIONS IN DOSIMETRY

New highly sensitive optically stimulated luminescent phosphors with NaCl moiety and dopants Ca,Cu,P/Mg,Cu,P are developed. These phosphors show very high optically stimulated luminescence (OSL) sensitivity. The dose response for NaCl:Ca,Cu,P is linear up to 1.2 Gy and for NaCl:Mg,Cu,P is slightly sub linear from 0.2 Gy. These phosphors show 30% fading during first 4 and later signal gets stabilised with no further signal loss. These sensitive phosphors will find applications in radiation dosimetry using OSL.

Pattern of acute MI admissions in India during COVID-19 era: A Cardiological Society of India study - Rationale and design

Background

COVID-19 pandemic has affected around 20million patients worldwide and 2.0 million cases from India. The lockdown was employed to delay the pandemic. However, it had an unintentional impact on acute cardiovascular care, especially acute myocardial infarction (AMI). Observational studies have shown a decrease in hospital admissions for AMI in several developed countries during the pandemic period. We aimed to evaluate the impact of COVID-19 on the AMI admissions patterns across India.

Methods

In this multicentric, retrospective, cross-sectional study, we included all AMI cases admitted to participating hospitals during the study period 15th March to 15th June 2020 and compared them using a historical control of all cases of AMI admitted during the corresponding period in the year 2019. Major objective of the study is to analyze the changes inthe number of hospital admissions for AMI in hospitals across India. In addition, we intend to evaluate the impact of COVID-19 on the weekly AMI admission rates, and other performance measures like rates of thrombolysis/primary percutaneous interventions (PCI), window period, door to balloon time, and door to needle time. Other objectives include evaluation of changes in the major complications and mortality rates of AMI and its predictors during COVID-19 pandemic.

Conclusions

This CSI-AMI study will provide scientific evidence about the impact of COVID-19 on AMI care in India. Based on this study, we may be able to suggest appropriate changes to the existing MI guidelines and to educate the public regarding emergency care for AMI during COVID-19 pandemic.

PHASE DEPENDENT OPTICALLY STIMULATED LUMINESCENCE IN CU-DOPED Sr4Si3O8Cl4

Phase dependent optically stimulated luminescence (OSL) is studied in Cu-doped Sr4Si3O8Cl4. The Study shows that samples in which amount of contributing strontium metasilicate phase in Cu-doped Sr4Si3O8Cl4 is less, show intense OSL while those samples in which strontium metasilicate phase is more show weak OSL. The observed Cu luminescence is also found to be phase dependent. Sample in which Sr4Si3O8Cl4 phase is dominant, the observed Cu luminescence is around 350 nm whereas an additional longer wavelength band around 450 nm is observed when the strontium metasilicate phase is present in significant amount. The relatively phase pure, Cu-doped Sr4Si3O8Cl4 shows good OSL properties. The sensitivity of such material is 3.89 times more compared to commercial Al2O3:C (Landauer Inc.). High sensitivity, good linearity and reusability, along with low fading make this material as good OSL phosphor and may find applications in OSL based radiation dosimetry.

PHOTOLUMINESCENCE, THERMOLUMINESCENCE AND OPTICALLY STIMULATED LUMINESCENCE STUDIES IN ZINC-BASED FLUOROPERVOSKITES

The optically stimulated luminescence, thermoluminescence and photoluminescence in various Cu and Ag doped zinc based fluoropervoskites are studied. In all the samples, photoluminescence of Cu+ and Ag+ is observed which could be attributed to 3d94 s1←→3d10 and 4d95 s1←→5d10 transitions, respectively. The observed emission is double humped and the main emission band shifts to the lower wavelength side with increasing ionic size of the alkali ion. All the studied fluoropervoskites show reasonable OSL sensitivity. Highest sensitivity is observed for Cu doped ZnNaF3 and is 25% compared to commercial Al2O3:C. Weak thermoluminescence is observed in all samples. In all Ag doped samples the TL peak is observed at 200°C whereas for Cu doped samples peak is observed at 150°C, and correlated with the OSL. The samples show good linear dose response in the 10 mGy-1.2 Gy range and show good reusability characteristics. This study will lead to the development of zinc-based fluoropervoskite phosphors for the radiation dosimetry using OSL.

Optically stimulated luminescence study in rare earth doped SrBPO5

Optically stimulated luminescence (OSL) was studied in rare earth doped SrBPO₅ for the possible applications in radiation dosimetry using optically stimulated luminescence. The study shows that the sensitivity of the Eu doped SrBPO₅ shows good OSL and the sensitivity is comparable to that of Al₂O₃:C. It is observed that annealing has a profound effect on the OSL sensitivity. Slowly cooled Eu doped sample shows highest sensitivity and is 77% compared to that Al₂O₃:C whereas lowest sensitivity is observed in the quenched sample. Other properties like good linearity and low fading will make this phosphor suitable for the applications in radiation dosimetry using OSL.

Effect of Al(3+) co-doping on the luminescence properties of Cu doped Na2SiF6

Studies were carried out to assess the correlation between thermoluminescence (TL) and optically stimulated luminescence (OSL) of this phosphor. It was observed that the OSL and TL glow curve consists of a wide distribution of traps having different photo-ionization cross-sections, trap depths and frequency factors. In case of Al doped sample, some of the traps up to 200°C are assumed to act as a source traps for the observance of OSL due to thermal transfer of charge carriers into the deep traps beyond 480°C. This suggests that Al impurities play an important role in the thermal transfer OSL process. As most of the work on this phenomenon is done on natural materials (mainly quartz) in which aluminum is a natural impurity, this study will explain the role of Al in this phenomenon.

A new highly sensitive low-Z LiF-based OSL phosphor for radiation dosimetry

A new low-Z lithium fluoride-based optical stimulated luminescent (OSL) phosphor is developed. The phosphor shows good OSL properties, and its sensitivity is comparable with that of the commercial Al2O3:C (Landauer, Inc.) phosphor. For the luminescence averaged over initial 3 s, blue stimulated luminescence (BSL) and green stimulated luminescence (GSL) sensitivities were found to be 0.27 and 4 times, respectively, than that of Al2O3:C (Landauer, Inc.). The BSL decay is fast, and the whole signal decays within 3 s; the GSL decay is relatively slow, and the signal decays in 25 s. The fast decay, good sensitivity, good linearity and its near tissue equivalence (Zeff ∼8.14) will make this phosphor suitable for radiation dosimetry particularly in personnel as well as in medical dosimetry.

Optically stimulated luminescence studies in combustion synthesized Al₂O₃:C,Cu,P

A new Al2O3:C,Cu,P phosphor is developed by the combustion synthesis technique which exhibits entirely different OSL properties as compared to that of the commercial alumina. No thermoluminescence (TL) is observed in this phosphor which also differentiates the present phosphor from the commercially available Al2O3:C (Landauer). The phosphor shows good optically stimulated luminescence (OSL) sensitivity for ionizing radiation with a fast OSL decay as compared to the commercial Al2O3:C. The phosphor heated in air followed by heating under the reactive atmosphere exhibits maximum sensitivity amongst several other phosphors. On the basis of area integration method; integrated over initial 3s, the sensitivity of this phosphor is about 67% of that of commercial Al2O3:C.

Na2SiF6:Cu,P: a new OSL phosphor for the radiation dosimetric applications

A new Cu,P-doped, sodium fluorosilicate-based optically stimulated luminescence (OSL) phosphor is developed. This phosphor shows good OSL properties, and the sensitivity is comparable with that of the commercial Al(2)O(3):C (Landauer, Inc.) phosphor. For the luminescence averaged over initial 1 s, blue-stimulated luminescence and green-stimulated luminescence sensitivities were found to be 0.76 and 3.8 times, respectively, of Al(2)O(3):C (Landauer, Inc.) with 28 % of post-irradiation fading in 3 days and nil thereafter. The simple preparation procedure, fast decay, very good sensitivity and moderate fading will make this phosphor suitable for radiation dosimetry, using OSL.

Hypolipidemic and antioxidant activity of ethanolic extract of Symplocos racemosa Roxb. in hyperlipidemic rats: an evidence of participation of oxidative stress in hyperlipidemia

Hypolipidemic and antioxidant activity profiles of ethanolic extracts of Symplocos racemosa (EESR) were studied by triton-WR1339 (acute) and high fat diet induced (chronic) hyperlipidemic rat models. In both the models, a significant increase in total cholesterol (TC), triglycerides (TG), very low density lipoproteins (VLDL), low density lipoproteins (LDL) and decrease in high density lipoproteins (HDL) in serum were observed. EESR (200 and 400 mg/kg) and simvastatin (10 mg/kg) administered orally reduced the elevated serum lipids (TC, TG, VLDL, LDL), restored the decreased HDL and improved the atherogenic index. In high fat diet induced hyperlipidemic model, EESR treatment prevented the increased formation of malondialdehyde (MDA) in liver, restored the depleted liver antioxidants, glutathione, superoxide dismutase, catalase significantly. The increased liver cholesterol, HMG-CoA reductase activity and body weight of hyperlipidemic rats were significantly reduced by EESR treatment. The EESR inhibited HMG-CoA reductase, a rate limiting enzyme in cholesterol biosynthesis, thereby causing hypolipidemic effects. EESR treatment also improved histoarchitecture of hepatocytes in hyperlipidemic rats. Experimental findings demonstrated anti-hyperlipidemic and antioxidant activity of EESR, which may be directly or indirectly related to its antioxidant activity. The hypolipidemic activity of EESR may be due to the presence of flavonoids phenolic compounds, phenolic glycosides and steroids.

Operational feasibility of establishing community reporting systems

BACKGROUND

In developing countries the absence ofa credible disease surveillance system results in an inappropriate response to an outbreak. Since a functioning and responsive disease surveillance system cannot be provided immediately, some interim surveillance system for early detection of outbreaks is needed to institute a prompt response. This operational research study was conducted to assess the feasibility of establishing community reporting systems involving women self-help groups and members of Panchayati raj institutions through syndromic surveillance at the community level.

METHODS

Reporting was initiated from 8 villages in 4 gram panchayats of Begunia block of Khurda district in Orissa during May and June 2005. Members of women self-help groups and Panchayati raj institutions were trained on structured reporting guidelines. In congruence with the state disease surveillance system, weekly reporting was started for comparison where feasible.

RESULTS

Completeness of reporting was better achieved by women self-help groups (91.6%) than members of Panchayati raj institutions (66.6%). Data capture was more complete as compared with the existing disease surveillance system. Illnesses among women were better captured and greater ownership of the public health service was noted.

CONCLUSION

Establishing community reporting systems using women self-help groups and members of Panchayat raj institutions for disease surveillance in India is a feasible option.

Granulocyte-macrophage colony-stimulating factor expression by human fibroblasts is both upregulated and subsequently downregulated by interleukin-1

Interleukin-1 (IL-1) treatment of human WI-38 lung fibroblasts results in granulocyte-macrophage colony-stimulating factor (GM-CSF) expression as well as a delayed increase in prostaglandin E2 (PGE2) production that closely correlates with the decline of GM-CSF mRNA levels. Pretreatment with PGE2 reduces the IL-1 induced GM-CSF mRNA and protein expression to 10% to 15% of control values at concentrations of PGE2 that are endogenously produced after IL-1 stimulation. Inhibition of PGE2 synthesis by indomethacin prolongs the IL-1 induced GM-CSF mRNA expression and increases the cumulative GM-CSF protein secretion. Exposure of WI-38 fibroblasts to PGE2 results in an increase in intracellular cyclic adenosine monophosphate (cAMP) levels. The inhibition of GM-CSF expression by PGE2 can be mimicked by stable cAMP analogs as well as cAMP elevating agents such as cholera toxin, forskolin, and isobutylmethylxanthine. Thus the inhibition exerted by PGE2 is mediated via cAMP. Taken together, these results suggest that IL-1 stimulation of human fibroblasts provides not only the upregulatory signal for GM-CSF expression but also a delayed and indirect downregulatory signal that serves to limit GM-CSF expression in the continued presence of IL-1.

Idiopathic extensive spontaneous venous thrombosis (a case report)

Two patients with extensive spontaneous venous thrombosis are reported. Both had documented evidence of polyserositis, transient abnormalities of liver function tests along with normal coagulograms. Although one patient had a short, self-limiting illness, the other required treatment with coumarin derivatives. The relevant literature is discussed.